Improving the interpersonal competences of head nurses through Peplau's theoretical active learning approach

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Tutik Sri" "apellidos" => "Hariyati" ] 1 => array:2 [ "nombre" => "Satina" "apellidos" => "Safril" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S113086211830055X?idApp=UINPBA00004N" "url" => "/11308621/00000028000000S1/v4_201810090949/S113086211830055X/v4_201810090949/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Improving the interpersonal competences of head nurses through Peplau's theoretical active learning approach" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "149" "paginaFinal" => "153" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => " Suhariyanto, Rr. Tutik Sri Hariyati, Titin Ungsianik" "autores" => array:3 [ 0 => array:2 [ "apellidos" => "Suhariyanto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Rr. Tutik Sri" "apellidos" => "Hariyati" "email" => array:1 [ 0 => "rrtutik@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Titin" "apellidos" => "Ungsianik" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Dr. Abdul Aziz Hospital, Singkawang, Indonesia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculty of Nursing, Universitas Indonesia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 656 "Ancho" => 959 "Tamanyo" => 85698 ] ] "descripcion" => array:1 [ "en" => "Mean values of head nurses’ skills in the interpersonal relationships (n=30)." ] ] ] "textoCompleto" => "IntroductionIt is crucial for head nurses to have excellent interpersonal skills. There is ample evidence showing the importance of interpersonal skills in achieving an organization's goals. One study indicated the vital role of head nurses is providing continuous support and direction for their staff in implementing infection prevention and control programs<a class="elsevierStyleCrossRef" href="#bib0005">1</a>. Another study showed that a close rapport between head nurses and their staff could improve their working performance<a class="elsevierStyleCrossRef" href="#bib0010">2</a>. In fact, support and motivation from head nurses would encourage better discipline of their staff members in developing their knowledge and abilities<a class="elsevierStyleCrossRef" href="#bib0015">3</a>. Accordingly, interpersonal skills encompass the characteristics needed by head nurses at every activity level, including providing guidance, being a role model, and evaluating the work performance of nurses.The ability of head nurses to understand nurses’ behaviors requires a theoretical approach to nursing. The application of Peplau's theory, which is highly pertinent to interpersonal relationships, could help patients to cooperatively engage in their own nursing care<a class="elsevierStyleCrossRef" href="#bib0020">4</a>. In addition, Peplau's theory about interpersonal relation could be applied to change particular behaviors, including improving the cognitive, affective, and psychomotor abilities of the staff or patients<a class="elsevierStyleCrossRef" href="#bib0020">4</a>.Peplau's theory of interpersonal relations could be applied by head nurses to guide, motivate, and supervise their staffs. The application of Peplau's theory would benefit head nurses while providing supervision by playing the roles of a speaker/information resource, teacher, counselor, guardian, stranger, and leader<a class="elsevierStyleCrossRef" href="#bib0025">5</a>. These roles could help head nurses improve their interpersonal skills which are aimed at developing favorable behaviors<a class="elsevierStyleCrossRef" href="#bib0030">6</a>.In order to change nursing staff behaviors, it is important for head nurses to cultivate interpersonal skills. Capacity building is one of the keys for assuring that head nurses can gain these skills. Training, as one of the capacity building activities, could help head nurses to ameliorate their knowledge and abilities in leadership and interpersonal relationships in accordance with organizational needs<a class="elsevierStyleCrossRef" href="#bib0035">7</a>. Furthermore, training could raise head nurses’ awareness and change their knowledge from the state of not knowing to the state of knowing<a class="elsevierStyleCrossRef" href="#bib0040">8</a>.To date, most forms of training have tended to be tedious and not very interactive. Traditional training methods put the responsibility of learning entirely on the teacher; hence, only a one-way communication is developed<a class="elsevierStyleCrossRef" href="#bib0045">9</a>. Also, the training focuses on knowledge enhancement instead of balancing the focus on both improving the knowledge and improving psychomotor abilities<a class="elsevierStyleCrossRef" href="#bib0050">10</a>.Training with active learning methods could effectively improve both the knowledge and psychomotor abilities of head nurses in interpersonal relationships. The use of active learning methods would be helpful for head nurses in integrating reflective and critical thinking based on evidencebased nursing<a class="elsevierStyleCrossRef" href="#bib0055">11</a>. Moreover, the mixture of reflective and active learning methods could assist head nurses in finding possible solutions to meet the needs of their staff members and deal with their shortcomings<a class="elsevierStyleCrossRef" href="#bib0060">12</a>.Training with active learning methods is essential to improve the application of Peplau's theory of interpersonal relations. This study had the potential to enhance the head nurses’ interpersonal knowledge and skills by initiating training with active learning methods. The module/materials generated in this study could be the resource for improving the interpersonal skills of head nurses in any health-care facility. Furthermore, the study provided meaningful information about the effects of Peplau's theoretical approach of active learning on the improvement of head nurses’ interpersonal skills.MethodThis study used a quasi-experimental design of a single group pretest and post-test without control group, and it aimed to examine the effects of Peplau's theoretical approach of active learning to strengthen the interpersonal roles of head nurses. The study was conducted at the Bunda General Hospital of Jakarta, Indonesia because the hospital has a clear organizational structure and established standards for the head nurses. The study was conducted from December 2015 to May 2016. The sample population was the head room nurses at one private hospital in Jakarta. There were two sample targets, 25 head nurses and 30 activities of head nurses, and two instruments, a questionnaire to explore respondents’ knowledge related to interpersonal relationship and an observation sheet. A total sample of 25 head nurses was admitted to the study using the following inclusion criteria: head nurses who agreed to participate in the program and who also agreed to implement the interpersonal roles.The data were obtained using the accidental sampling technique on 30 observations, both before and after the strengthening program. The variables were the knowledge and skills of head nurses in implementing Peplau's interpersonal roles, including the variables of such roles as leader, stranger, guardian, counselor, speaker, and teacher.The strengthening program using active learning in this study was carried out in three phases: orientation, identification, and implementation and strengthening (resolution). The orientation phase was done through the needs assessment and the signing of the informed consent. During this initial stage, the researchers would also develop a module for trainings. The second phase was done using a cognitive pretest of 16 multiple-choice questions. Training programs conducted by the researchers using active learning of case-based learning, Gibbs self-reflection, and self-directed learning were used. A module of interpersonal skills was distributed to participants prior to the training. Lastly, the strengthening (resolution) phase consisted of assessing the competence of the head nurses using the observation sheet and arranging the follow-up plans.The framework of the study is illustrated in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The data were collected by the researchers before and after the strengthening program. An observation sheet tested for its content validity by nursing experts was the instrument used. A univariate analysis was performed for the characteristics of the head nurses with a central tendency method. Meanwhile, the knowledge and skills of the nurses were examined using statistical analysis by means of a paired t-test. Prior to its onset, this study was approved by the committee of ethics of the Faculty of Nursing, Universitas Indonesia.<a name="p3"></a>ResultsThe results of the study presented the interrelationships of head nurses’ knowledge and skills in interpersonal roles before and after participating in the strengthening programs using Peplau's theoretical approach of active learning.The mean value of head nurses’ knowledge after the strengthening programs was 7.45 higher than that prior to the training. The analysis, furthermore, showed that the increase was significant (P=.003) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Nevertheless, increases of mean values were found in all interpersonal skills after the strengthening program (third observation), and, despite that results, the scores were apt to remain stable or decline in the last observation. The mean score of skills in playing the role of leader was 43 before the strengthening program (first observation), increased to 60 after the program (third observation), and increased again to 85 in the last observation. Meanwhile, the mean score of skills in playing the role of stranger was 68 before the program, increased to 81 after the implementation, and dropped to 75 in the last observation (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Surprisingly, the findings demonstrated significant increases in the mean values of the head nurses’ skills in playing the role of leader (P=.006), guardian (P=.014), and teacher/speaker (P=.015). However, there were no significant increases in the mean values of the head nurses’ skills in playing the roles of counselor (P=0.092) and stranger (P=.182) (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>DiscussionOn average, the knowledge of the head nurses increased after the strengthening programs of the interpersonal roles using Peplau's theoretical approach. The increased knowledge of the head nurses is a process of active learning using self-directed learning, Gibbs self-reflection, and case-based learning techniques.Active learning would facilitate the processes of knowledge discovery, problem-solving, and analysis, as well as providing a demonstration of learning experiences<a class="elsevierStyleCrossRef" href="#bib0065">13</a>. In health-care facilities, active learning activities to promote manpower development might include participation, repetition, transfer, feedback, reflection, and case studies<a class="elsevierStyleCrossRef" href="#bib0070">14</a>. Small group discussions assisted by facilitators to address specific issues and identify possible solutions are often used. In active learning, discussions would provide opportunities to learn new behaviors, while the delivery of the material<a name="p4"></a> would help learners understand the particular roles to be performed<a class="elsevierStyleCrossRef" href="#bib0075">15</a>.The strengthening programs in the study employed Gibbs self-reflection and self-directed learning methods. These methods were performed by the head nurses sharing their experiences in implementing the standard operating procedures (SOPs) of the personal protective equipment (PPE) in their units. The steps helpful describing the events and feelings, evaluating, analyzing, concluding, and planning future actions. These learning methods would be helpful for the head nurses to better understand the challenges found in the workplace and improve self-control<a class="elsevierStyleCrossRef" href="#bib0080">16</a>. Moreover, one study stated that the Gibbs learning cycle is a systematically structured process involving emotions and thoughts<a class="elsevierStyleCrossRef" href="#bib0085">17</a> that provides insights useful to build the intended behaviors.The findings of this study demonstrated that the active teaching and learning process using Gibbs self-reflection, case-based learning, and self-directed learning significantly increased the mean scores of head nurses’ knowledge and skills in the interpersonal roles. The results were consistent with those reported in other studies. As an evaluation method, the Gibbs reflective learning approach effectively increased the knowledge of the head nurses. Likewise, a study in Jordan showed that the integration of practice and evaluation helped the respondents in acquiring new knowledge<a class="elsevierStyleCrossRef" href="#bib0090">18</a>.In addition to resulting in knowledge improvement, the strengthening programs using active learning methods improved the head nurses’ skills in playing the roles of leader, guardian, and teacher. This result was consistent with one study which proved that self-directed learning during the first clinical practice of Saudi nursing and medical students in hospitals significantly improved their patient safety competences, discussing the problems faced while doing demonstrations, and drawing the possible solutions for future challenges. In the same study, the self-directed learning included reviewing journals, demonstrating clinical skills with peers<a class="elsevierStyleCrossRef" href="#bib0095">19</a>. Another study in China showed that self-direct-ed learning helped new nurses learn independently while aiming at developing their abilities in analyzing issues found in hospitals<a class="elsevierStyleCrossRef" href="#bib0100">20</a>.To better understand the interpersonal competences, the strengthening program highlighted the importance of interactions, eye contact, and information exchange between head nurses and their coworkers/subordinates during work and between the head nurses and the training instructors during the training. These activities could promote selfconfidence and improve communication skills. In addition, the activities could enhance the personal and professional growth of the head nurses<a class="elsevierStyleCrossRef" href="#bib0105">21</a>." "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres1092611" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Purpose" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Method" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions and recommendations" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1035483" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Method" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1035483" "palabras" => array:5 [ 0 => "Leadership" 1 => "Teaching" 2 => "Interpersonal" 3 => "Peplau" 4 => "Active learning" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundEffective interpersonal skills are essential for head nurses in governing and managing their work units. Therefore, an active learning strategy could be the key to enhance the interpersonal competences of head nurses. PurposeThis study aimed to investigate the effects of Peplau's theoretical approach of active learning on the improvement of head nurses’ interpersonal skills. MethodThis study used a pre-experimental design with one group having pretests and posttests, without control group. A total sample of 25 head nurses from inpatient units of a wellknown private hospital in Jakarta was involved in the study. Data were analyzed using the paired t-test. ResultsThe results showed a significant increase in head nurses’ knowledge following the training to strengthen their interpersonal roles (P=.003). The results also revealed significant increases in the head nurses’ skills in playing the roles of leader (P=.006), guardian (P=.014), and teacher/speaker (P=.015). Nonetheless, the results showed no significant increases in the head nurses’ skills in playing the roles of counselor (P=.092) and stranger (P=.182). Conclusions and recommendationsTraining in strengthening the interpersonal roles of head nurses significantly increased the head nurses’ knowledge and skills. The results of the study suggested the continuation of active learning strategies to improve the interpersonal abilities of head nurses. Furthermore, these strategies could be used to build the abilities of head nurses in other managerial fields.<a name="p2"></a>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Purpose" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Method" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions and recommendations" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 715 "Ancho" => 1675 "Tamanyo" => 167173 ] ] "descripcion" => array:1 [ "en" => "Framework of the study." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 656 "Ancho" => 959 "Tamanyo" => 85698 ] ] "descripcion" => array:1 [ "en" => "Mean values of head nurses’ skills in the interpersonal relationships (n=30)." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 592 "Ancho" => 986 "Tamanyo" => 50703 ] ] "descripcion" => array:1 [ "en" => "The ability of interpersonal role the head space with the Peplau theoretical approach." ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Strengthening \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Diff \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">95%CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pre-strengthening \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.816 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.70-8.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.003*** \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Post-strengthening \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.957 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.73-15.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1868536.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Mean values of head nurses’ knowledge in interpersonal relationships (n=25)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identifying What Rural Health Workers in Malawi Need to Become HIV Prevention Leaders" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.L. 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Suhariyantoa, Rr. Tutik Sri Hariyatib,

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rrtutik@yahoo.com

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, Titin Ungsianikb

a Dr. Abdul Aziz Hospital, Singkawang, Indonesia

b Faculty of Nursing, Universitas Indonesia

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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Mean values of head nurses&#8217; skills in the interpersonal relationships &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">It is crucial for head nurses to have excellent interpersonal skills&#46; There is ample evidence showing the importance of interpersonal skills in achieving an organization&#39;s goals&#46; One study indicated the vital role of head nurses is providing continuous support and direction for their staff in implementing infection prevention and control programs<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; Another study showed that a close rapport between head nurses and their staff could improve their working performance<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; In fact&#44; support and motivation from head nurses would encourage better discipline of their staff members in developing their knowledge and abilities<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; Accordingly&#44; interpersonal skills encompass the characteristics needed by head nurses at every activity level&#44; including providing guidance&#44; being a role model&#44; and evaluating the work performance of nurses&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The ability of head nurses to understand nurses&#8217; behaviors requires a theoretical approach to nursing&#46; The application of Peplau&#39;s theory&#44; which is highly pertinent to interpersonal relationships&#44; could help patients to cooperatively engage in their own nursing care<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; In addition&#44; Peplau&#39;s theory about interpersonal relation could be applied to change particular behaviors&#44; including improving the cognitive&#44; affective&#44; and psychomotor abilities of the staff or patients<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Peplau&#39;s theory of interpersonal relations could be applied by head nurses to guide&#44; motivate&#44; and supervise their staffs&#46; The application of Peplau&#39;s theory would benefit head nurses while providing supervision by playing the roles of a speaker&#47;information resource&#44; teacher&#44; counselor&#44; guardian&#44; stranger&#44; and leader<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; These roles could help head nurses improve their interpersonal skills which are aimed at developing favorable behaviors<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In order to change nursing staff behaviors&#44; it is important for head nurses to cultivate interpersonal skills&#46; Capacity building is one of the keys for assuring that head nurses can gain these skills&#46; Training&#44; as one of the capacity building activities&#44; could help head nurses to ameliorate their knowledge and abilities in leadership and interpersonal relationships in accordance with organizational needs<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; Furthermore&#44; training could raise head nurses&#8217; awareness and change their knowledge from the state of not knowing to the state of knowing<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">To date&#44; most forms of training have tended to be tedious and not very interactive&#46; Traditional training methods put the responsibility of learning entirely on the teacher&#59; hence&#44; only a one-way communication is developed<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Also&#44; the training focuses on knowledge enhancement instead of balancing the focus on both improving the knowledge and improving psychomotor abilities<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Training with active learning methods could effectively improve both the knowledge and psychomotor abilities of head nurses in interpersonal relationships&#46; The use of active learning methods would be helpful for head nurses in integrating reflective and critical thinking based on evidencebased nursing<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Moreover&#44; the mixture of reflective and active learning methods could assist head nurses in finding possible solutions to meet the needs of their staff members and deal with their shortcomings<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Training with active learning methods is essential to improve the application of Peplau&#39;s theory of interpersonal relations&#46; This study had the potential to enhance the head nurses&#8217; interpersonal knowledge and skills by initiating training with active learning methods&#46; The module&#47;materials generated in this study could be the resource for improving the interpersonal skills of head nurses in any health-care facility&#46; Furthermore&#44; the study provided meaningful information about the effects of Peplau&#39;s theoretical approach of active learning on the improvement of head nurses&#8217; interpersonal skills&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Method</span><p id="par0040" class="elsevierStylePara elsevierViewall">This study used a quasi-experimental design of a single group pretest and post-test without control group&#44; and it aimed to examine the effects of Peplau&#39;s theoretical approach of active learning to strengthen the interpersonal roles of head nurses&#46; The study was conducted at the Bunda General Hospital of Jakarta&#44; Indonesia because the hospital has a clear organizational structure and established standards for the head nurses&#46; The study was conducted from December 2015 to May 2016&#46; The sample population was the head room nurses at one private hospital in Jakarta&#46; There were two sample targets&#44; 25 head nurses and 30 activities of head nurses&#44; and two instruments&#44; a questionnaire to explore respondents&#8217; knowledge related to interpersonal relationship and an observation sheet&#46; A total sample of 25 head nurses was admitted to the study using the following inclusion criteria&#58; head nurses who agreed to participate in the program and who also agreed to implement the interpersonal roles&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The data were obtained using the accidental sampling technique on 30 observations&#44; both before and after the strengthening program&#46; The variables were the knowledge and skills of head nurses in implementing Peplau&#39;s interpersonal roles&#44; including the variables of such roles as leader&#44; stranger&#44; guardian&#44; counselor&#44; speaker&#44; and teacher&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The strengthening program using active learning in this study was carried out in three phases&#58; orientation&#44; identification&#44; and implementation and strengthening &#40;resolution&#41;&#46; The orientation phase was done through the needs assessment and the signing of the informed consent&#46; During this initial stage&#44; the researchers would also develop a module for trainings&#46; The second phase was done using a cognitive pretest of 16 multiple-choice questions&#46; Training programs conducted by the researchers using active learning of case-based learning&#44; Gibbs self-reflection&#44; and self-directed learning were used&#46; A module of interpersonal skills was distributed to participants prior to the training&#46; Lastly&#44; the strengthening &#40;resolution&#41; phase consisted of assessing the competence of the head nurses using the observation sheet and arranging the follow-up plans&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The framework of the study is illustrated in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The data were collected by the researchers before and after the strengthening program&#46; An observation sheet tested for its content validity by nursing experts was the instrument used&#46; A univariate analysis was performed for the characteristics of the head nurses with a central tendency method&#46; Meanwhile&#44; the knowledge and skills of the nurses were examined using statistical analysis by means of a paired <span class="elsevierStyleItalic">t</span>-test&#46; Prior to its onset&#44; this study was approved by the committee of ethics of the Faculty of Nursing&#44; Universitas Indonesia&#46;<a name="p3"></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The results of the study presented the interrelationships of head nurses&#8217; knowledge and skills in interpersonal roles before and after participating in the strengthening programs using Peplau&#39;s theoretical approach of active learning&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The mean value of head nurses&#8217; knowledge after the strengthening programs was 7&#46;45 higher than that prior to the training&#46; The analysis&#44; furthermore&#44; showed that the increase was significant &#40;<span class="elsevierStyleItalic">P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;</span>003&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Nevertheless&#44; increases of mean values were found in all interpersonal skills after the strengthening program &#40;third observation&#41;&#44; and&#44; despite that results&#44; the scores were apt to remain stable or decline in the last observation&#46; The mean score of skills in playing the role of leader was 43 before the strengthening program &#40;first observation&#41;&#44; increased to 60 after the program &#40;third observation&#41;&#44; and increased again to 85 in the last observation&#46; Meanwhile&#44; the mean score of skills in playing the role of stranger was 68 before the program&#44; increased to 81 after the implementation&#44; and dropped to 75 in the last observation &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Surprisingly&#44; the findings demonstrated significant increases in the mean values of the head nurses&#8217; skills in playing the role of leader &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;006&#41;&#44; guardian &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;014&#41;&#44; and teacher&#47;speaker &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;015&#41;&#46; However&#44; there were no significant increases in the mean values of the head nurses&#8217; skills in playing the roles of counselor &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;092&#41; and stranger &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;182&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">On average&#44; the knowledge of the head nurses increased after the strengthening programs of the interpersonal roles using Peplau&#39;s theoretical approach&#46; The increased knowledge of the head nurses is a process of active learning using self-directed learning&#44; Gibbs self-reflection&#44; and case-based learning techniques&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Active learning would facilitate the processes of knowledge discovery&#44; problem-solving&#44; and analysis&#44; as well as providing a demonstration of learning experiences<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; In health-care facilities&#44; active learning activities to promote manpower development might include participation&#44; repetition&#44; transfer&#44; feedback&#44; reflection&#44; and case studies<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; Small group discussions assisted by facilitators to address specific issues and identify possible solutions are often used&#46; In active learning&#44; discussions would provide opportunities to learn new behaviors&#44; while the delivery of the material<a name="p4"></a> would help learners understand the particular roles to be performed<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The strengthening programs in the study employed Gibbs self-reflection and self-directed learning methods&#46; These methods were performed by the head nurses sharing their experiences in implementing the standard operating procedures &#40;SOPs&#41; of the personal protective equipment &#40;PPE&#41; in their units&#46; The steps helpful describing the events and feelings&#44; evaluating&#44; analyzing&#44; concluding&#44; and planning future actions&#46; These learning methods would be helpful for the head nurses to better understand the challenges found in the workplace and improve self-control<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; Moreover&#44; one study stated that the Gibbs learning cycle is a systematically structured process involving emotions and thoughts<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> that provides insights useful to build the intended behaviors&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The findings of this study demonstrated that the active teaching and learning process using Gibbs self-reflection&#44; case-based learning&#44; and self-directed learning significantly increased the mean scores of head nurses&#8217; knowledge and skills in the interpersonal roles&#46; The results were consistent with those reported in other studies&#46; As an evaluation method&#44; the Gibbs reflective learning approach effectively increased the knowledge of the head nurses&#46; Likewise&#44; a study in Jordan showed that the integration of practice and evaluation helped the respondents in acquiring new knowledge<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In addition to resulting in knowledge improvement&#44; the strengthening programs using active learning methods improved the head nurses&#8217; skills in playing the roles of leader&#44; guardian&#44; and teacher&#46; This result was consistent with one study which proved that self-directed learning during the first clinical practice of Saudi nursing and medical students in hospitals significantly improved their patient safety competences&#44; discussing the problems faced while doing demonstrations&#44; and drawing the possible solutions for future challenges&#46; In the same study&#44; the self-directed learning included reviewing journals&#44; demonstrating clinical skills with peers<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46; Another study in China showed that self-direct-ed learning helped new nurses learn independently while aiming at developing their abilities in analyzing issues found in hospitals<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">To better understand the interpersonal competences&#44; the strengthening program highlighted the importance of interactions&#44; eye contact&#44; and information exchange between head nurses and their coworkers&#47;subordinates during work and between the head nurses and the training instructors during the training&#46; These activities could promote selfconfidence and improve communication skills&#46; In addition&#44; the activities could enhance the personal and professional growth of the head nurses<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Effective interpersonal skills are essential for head nurses in governing and managing their work units&#46; Therefore&#44; an active learning strategy could be the key to enhance the interpersonal competences of head nurses&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Purpose</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This study aimed to investigate the effects of Peplau&#39;s theoretical approach of active learning on the improvement of head nurses&#8217; interpersonal skills&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Method</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This study used a pre-experimental design with one group having pretests and posttests&#44; without control group&#46; A total sample of 25 head nurses from inpatient units of a wellknown private hospital in Jakarta was involved in the study&#46; Data were analyzed using the paired <span class="elsevierStyleItalic">t</span>-test&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The results showed a significant increase in head nurses&#8217; knowledge following the training to strengthen their interpersonal roles &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41;&#46; The results also revealed significant increases in the head nurses&#8217; skills in playing the roles of leader &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;006&#41;&#44; guardian &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;014&#41;&#44; and teacher&#47;speaker &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;015&#41;&#46; Nonetheless&#44; the results showed no significant increases in the head nurses&#8217; skills in playing the roles of counselor &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;092&#41; and stranger &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;182&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions and recommendations</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Training in strengthening the interpersonal roles of head nurses significantly increased the head nurses&#8217; knowledge and skills&#46; The results of the study suggested the continuation of active learning strategies to improve the interpersonal abilities of head nurses&#46; Furthermore&#44; these strategies could be used to build the abilities of head nurses in other managerial fields&#46;<a name="p2"></a></p></span>"
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Article information

ISSN: 11308621
Original language: English

DOI:10.1016/S1130-8621(18)30056-1

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Year/Month	Html	Pdf	Total

2024 October	44	14	58
2024 September	107	49	156
2024 August	86	28	114
2024 July	63	8	71
2024 June	60	11	71
2024 May	78	6	84
2024 April	91	14	105
2024 March	81	22	103
2024 February	71	8	79
2024 January	109	7	116
2023 December	122	7	129
2023 November	162	15	177
2023 October	207	34	241
2023 September	221	89	310
2023 August	134	8	142
2023 July	136	4	140
2023 June	105	4	109
2023 May	169	14	183
2023 April	134	10	144
2023 March	152	13	165
2023 February	109	11	120
2023 January	90	7	97
2022 December	83	12	95
2022 November	137	12	149
2022 October	108	18	126
2022 September	106	19	125
2022 August	117	8	125
2022 July	95	14	109
2022 June	73	17	90
2022 May	75	10	85
2022 April	77	14	91
2022 March	104	26	130
2022 February	90	14	104
2022 January	149	9	158
2021 December	121	33	154
2021 November	112	25	137
2021 October	129	17	146
2021 September	107	24	131
2021 August	82	13	95
2021 July	91	19	110
2021 June	68	16	84
2021 May	83	17	100
2021 April	230	30	260
2021 March	143	30	173
2021 February	66	13	79
2021 January	80	29	109
2020 December	161	29	190
2020 November	105	35	140
2020 October	48	25	73
2020 September	82	26	108
2020 August	71	14	85
2020 July	65	11	76
2020 June	56	12	68
2020 May	78	34	112
2020 April	97	22	119
2020 March	86	15	101
2020 February	72	22	94
2020 January	61	27	88
2019 December	75	37	112
2019 November	96	36	132
2019 October	110	47	157
2019 September	76	33	109
2019 August	30	11	41
2019 July	36	20	56
2019 June	48	16	64
2019 May	105	24	129
2019 April	53	15	68
2019 March	6	10	16
2018 December	6	0	6
2018 November	1	0	1
2018 April	1	0	1

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